<p>Purpose: This study aimed to evaluate the impact of robot-assisted cortical bone trajectory (CBT) screw placement under an enhanced recovery after surgery (ERAS) protocol compared to traditional freehand CBT placement on perioperative outcomes and postoperative recovery in patients undergoing midline lumbar interbody fusion (MIDLIF). Methods: In this retrospective study, 81 patients with degenerative lumbar spine disease who underwent single-level L4/5 MIDLIF between January 2020 and June 2025 were analyzed. Patients were divided into two groups: 37 underwent freehand CBT screw placement (control group), and 44 received robot-assisted CBT screw placement within the ERAS protocol (ERAS group). The comparison involved various perioperative metrics, such as drainage volume, blood loss, operative duration, rate of transfusion, use of analgesics, occurrence of postoperative vomiting, length of hospital stay (LOS), and complications. Pain levels and functional outcomes were evaluated with the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) both before surgery and after one year. Results: The ERAS group experienced significantly less blood loss, reduced drainage volume, decreased analgesic requirements, and a lower incidence of vomiting compared to the control group (<i>P</i> &lt; 0.05). LOS was shorter in the ERAS group (4.27 vs. 5.03 days, <i>P</i> = 0.001). Although the surgical duration was extended in the ERAS group, the complication rates did not differ significantly. Significant enhancements in VAS and ODI scores were observed in both groups one year after surgery (<i>P</i> &lt; 0.001). Conclusion: The integration of robot-assisted CBT screw placement with the ERAS protocol presents considerable benefits for perioperative care and recovery after surgery, while not elevating the risk of complications. This method could prove to be a vital approach for improving surgical results and encouraging the wider implementation of ERAS in spinal operations.</p>